CASE REPORT / ПРИКАЗ БОЛЕСНИКА Lateral periodontal cyst ... · 1. Shear M, Speight...
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70 Correspondence to: Daniela ADORNO-FARIAS Av. Araújo Pinho, 62 – 9° andar – Canela CEP: 40110-150 Salvador, Bahia Brasil [email protected] Примљено • Received: September 2, 2016 Прихваћено • Accepted: June 9, 2016 Online first: June 13, 2017 DOI: https://doi.org/10.2298/SARH160902129A UDC: 616.314.21/.22-003.4 SUMMARY Introduction Lateral periodontal cysts (LPC) are not frequent and the diagnosis is generally established by means of a routine radiological exploration. The aim of this article is to report a case of LPC on edentulous area. Case outline A 59-year-old man was referred with an extensive radiolucent cystic lesion on edentulous area of anterior maxilla, with a clinical and radiographic diagnosis of residual cyst. The histopathologic features exhibited a diagnosis of LPC. Conclusion This is the third case of LPC reported in the literature, which describes a different clinical and radiographic aspect than proposed in the literature. Keywords: lateral periodontal cyst; residual cyst; edentulous area CASE REPORT / ПРИКАЗ БОЛЕСНИКА Lateral periodontal cyst simulating a residual cyst Daniela Adorno-Farias 1,2 , Frederico Sampaio Neves 3 , Braulio Carneiro Júnior 1 , Jean Nunes dos Santos 4 1 Federal University of Bahia, School of Dentistry, Salvador, Bahia, Brazil; 2 University of Chile, School of Dentistry, Department of Oral Pathology and Medicine, Santiago, Chile; 3 Federal University of Bahia, School of Dentistry, Department of Oral and Maxillofacial Radiology, Salvador, Bahia, Brazil; 4 Federal University of Bahia, School of Dentistry, Department of Propaedeutics and Integrated Clinic, Surgical Pathology Laboratory, Salvador, Bahia, Brazil INTRODUCTION Lateral periodontal cysts (LPC) comprise about 0.4% of all odontogenic cysts and since the last classification the World Health Organization (WHO) they have been defined as odontogenic cysts located beside or lateral to a vital tooth, whose inflammatory cause has been excluded [1–6]. This cyst originates from the remnants of odontogenic epithelium [4]. Histologically, it consists of a fibrous cystic wall lined by a nonkeratinized squamous cuboi- dal epithelium, comprising from one to five lay- ers of cells [3–10]. It is also characterized by the presence of composite plaques epithelial cells and clear cells, rich in glycogen [5, 6, 7]. Some publications show a male predilection [2, 5–8]. These lesions are more common in adults dur- ing the fifth to seventh decades of life [8], and are located in the mandibular premolar area [1]. Radiographically, LPCs are mostly radiolucent, unilocular, oval- or teardrop-shaped lesions, lo- cated between the roots of vital teeth and are circumscribed by a sclerotic halo [7–11]. Although according to the WHO LPC must be adjacent the root of a tooth pulp vitality, we describe a case of residual LPC whose histo- pathology was essential for determining its nature [4]. CASE REPORT A 59-year-old man was referred to us because of an asymptomatic lesion in the oral cavity with a six-month history of evolution. The intraoral examination showed the presence of swelling in the edentulous part of the anterior left segment of the maxilla, 1 cm in size, of soft consistency. The periapical and panoramic ra- diographs (Figures 1 and 2) revealed a well- circumscribed unilocular ovoid radiolucent area, extending from periapical area, at the na- sal cortical level, to the alveolar process, which approximately measured 2.3 × 1.5 cm in size. Erosion or expansion of the cortical bone was not observed. With these clinical and radio- graphic characteristics a presumptive diagnosis of residual cyst was reached. After excisional biopsy, the histopathologic features exhibited multiple cystic spaces lined by squamous atro- phic epithelium, consisting mainly of cuboidal cells exhibiting vacuoles in the basal layer and some clear cells. The fibrous cystic wall showed subepithelial hyalinization and protrusions into the lumen (Figures 3 and 4). On the basis of these findings, a diagnosis of LPC was made. DISCUSSION Most publications about LPC are case or series reports with few patients, and studies of jaw cysts in the last ten years have still been report- ing low frequency of this pathology, ranging 0.12–1.7%, with a slight male preference, in patients with a wide age range (21–82 years), predominantly located in the premolar area of the mandible [1, 2, 12–17]. Being a small cyst in clinical practice, diagnosed in many cases
Transcript of CASE REPORT / ПРИКАЗ БОЛЕСНИКА Lateral periodontal cyst ... · 1. Shear M, Speight...
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Correspondence to:Daniela ADORNO-FARIASAv. Araújo Pinho, 62 – 9° andar – CanelaCEP: 40110-150 Salvador, BahiaBrasil [email protected]
Примљено • Received: September 2, 2016
Прихваћено • Accepted: June 9, 2016
Online first: June 13, 2017
DOI: https://doi.org/10.2298/SARH160902129A
UDC: 616.314.21/.22-003.4
SUMMARYIntroduction Lateral periodontal cysts (LPC) are not frequent and the diagnosis is generally established by means of a routine radiological exploration.The aim of this article is to report a case of LPC on edentulous area. Case outline A 59-year-old man was referred with an extensive radiolucent cystic lesion on edentulous area of anterior maxilla, with a clinical and radiographic diagnosis of residual cyst. The histopathologic features exhibited a diagnosis of LPC.Conclusion This is the third case of LPC reported in the literature, which describes a different clinical and radiographic aspect than proposed in the literature.Keywords: lateral periodontal cyst; residual cyst; edentulous area
CASE REPORT / ПРИКАЗ БОЛЕСНИКА
Lateral periodontal cyst simulating a residual cystDaniela Adorno-Farias1,2, Frederico Sampaio Neves3, Braulio Carneiro Júnior1, Jean Nunes dos Santos4
1Federal University of Bahia, School of Dentistry, Salvador, Bahia, Brazil; 2University of Chile, School of Dentistry, Department of Oral Pathology and Medicine, Santiago, Chile;3Federal University of Bahia, School of Dentistry, Department of Oral and Maxillofacial Radiology, Salvador, Bahia, Brazil;4Federal University of Bahia, School of Dentistry, Department of Propaedeutics and Integrated Clinic, Surgical Pathology Laboratory, Salvador, Bahia, Brazil
INTRODUCTION
Lateral periodontal cysts (LPC) comprise about 0.4% of all odontogenic cysts and since the last classification the World Health Organization (WHO) they have been defined as odontogenic cysts located beside or lateral to a vital tooth, whose inflammatory cause has been excluded [1–6]. This cyst originates from the remnants of odontogenic epithelium [4].
Histologically, it consists of a fibrous cystic wall lined by a nonkeratinized squamous cuboi-dal epithelium, comprising from one to five lay-ers of cells [3–10]. It is also characterized by the presence of composite plaques epithelial cells and clear cells, rich in glycogen [5, 6, 7]. Some publications show a male predilection [2, 5–8]. These lesions are more common in adults dur-ing the fifth to seventh decades of life [8], and are located in the mandibular premolar area [1]. Radiographically, LPCs are mostly radiolucent, unilocular, oval- or teardrop-shaped lesions, lo-cated between the roots of vital teeth and are circumscribed by a sclerotic halo [7–11].
Although according to the WHO LPC must be adjacent the root of a tooth pulp vitality, we describe a case of residual LPC whose histo-pathology was essential for determining its nature [4].
CASE REPORT
A 59-year-old man was referred to us because of an asymptomatic lesion in the oral cavity
with a six-month history of evolution. The intraoral examination showed the presence of swelling in the edentulous part of the anterior left segment of the maxilla, 1 cm in size, of soft consistency. The periapical and panoramic ra-diographs (Figures 1 and 2) revealed a well-circumscribed unilocular ovoid radiolucent area, extending from periapical area, at the na-sal cortical level, to the alveolar process, which approximately measured 2.3 × 1.5 cm in size. Erosion or expansion of the cortical bone was not observed. With these clinical and radio-graphic characteristics a presumptive diagnosis of residual cyst was reached. After excisional biopsy, the histopathologic features exhibited multiple cystic spaces lined by squamous atro-phic epithelium, consisting mainly of cuboidal cells exhibiting vacuoles in the basal layer and some clear cells. The fibrous cystic wall showed subepithelial hyalinization and protrusions into the lumen (Figures 3 and 4). On the basis of these findings, a diagnosis of LPC was made.
DISCUSSION
Most publications about LPC are case or series reports with few patients, and studies of jaw cysts in the last ten years have still been report-ing low frequency of this pathology, ranging 0.12–1.7%, with a slight male preference, in patients with a wide age range (21–82 years), predominantly located in the premolar area of the mandible [1, 2, 12–17]. Being a small cyst in clinical practice, diagnosed in many cases
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in a routine radiographic examination, this case differs from the WHO concept and previous studies because of the clinical and radiographic findings [1, 2–11].
To our knowledge, this case appears to be the second one reporting an LPC in the edentulous region, simulat-ing residual cyst. The cyst presented in the maxilla differs from the previous study of Mendes and van der Waal [11] that showed two residual LPC in the mandible. Although the usual location of LPC is mandible, when they occur in the maxilla they show a predilection for the anterior region, as in the case presented [1, 4].
It is important to note that despite the LPC reported in this work was oval in shape, differing from the residual cysts, which tend to be circular, it was larger than reported in the literature, which described lesions smaller than 1 cm [1, 4, 8, 9]. LPC may in some cases exhibit different behavior, with great growth potential. In addition, the behavior of this cyst is difficult to determine because of its low frequency [8].
Histopathological aspects of this case fulfil the precon-ditions for the LPC diagnosis [1, 3–11]. Our attention was caught by the presence of hyalinization in the capsule and by protrusions into the cystic lumen (Figure 4), which are not seen in radicular cyst.
The most appropriate treatment for this cyst is a com-plete surgical enucleation with low tendency to recurrence [1, 4]. As the reported LPC is larger than usual, a follow-up checkup every six months was recommended, with radiographic monitoring, because of a possible tendency to recurrence of this particular case.
The LPC described here is in accordance with Mendes and van der Waal [11] in the sense that clinical and radio-graphic features should hold less importance than histo-logical ones in future characterizations of this cyst in the literature, as histopathologic features were essential to the conclusion of this case.
Figure 1. Panoramic radiographic view of a well circumscribed radiolucency in the anterior maxilla; a presumptive diagnosis of residual cyst was made
Figure 2. Detail of the radiolucent lesion, which extends to the cortical alveolar process
Figure 3. Cystic cavity lined by squamous epithelial cells, bleeding area in the fibrous wall and protrusion into the lumen
Figure 4. Presence of hyalinization of the capsule and a few clear cells
Lateral periodontal cyst simulating a residual cyst
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DOI: https://doi.org/10.2298/SARH160902129A
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REFERENCES
САЖЕТАКУвод Латералне периодонталне цисте (ЛПЦ) нису честе, а дијагноза се поставља најчешће радиолошким прегледом.Циљ овог рада је да прикаже болесника са ЛПЦ у безубој регији.Приказ болесника Код мушкарца старог 59 година нађена је велика цистична радиолуцентна промена у безубој регији у предњем делу горње вилице и постављена клиничка и
радиолошка дијагноза резидуалне цисте. Патохистолошки преглед је потврдио дијагнозу ЛПЦ.Закључак Ово је трећи описани случај ЛПЦ, који по кли-никчким и радиографским аспектима одступа од претходно описаних случајева.
Кључне речи: латерална периодонтална циста; резидуална циста; безуба регија
Латерална периодонтална циста изгледа резидуалне цистеДанијела Адорно-Фаријас1,2, Фредерико Сампаио Невес3, Браулио Карнеиро Жуниор1, Жеан Нунес дос Сантос4
1Државни универзитет Баије, Стоматолошки факултет, Салвадор, Баија, Бразил; 2Универзитет Чилеа, Стоматолошки факултет, Катедра за оралну патологију и медицину, Сантијаго, Чиле;3Државни универзитет Баије, Стоматолошки факултет, Катедра за оралну и максилофацијалну радиологију, Салвадор, Баија, Бразил;4Државни универзитет Баије, Стоматолошки факултет, Катедра за пропедевтику и Интегрисана клиника, Хируршка патохистолошка лабораторија, Салвадор, Баија, Бразил
Adorno-Farias D. et al.
